Healthcare Provider Details

I. General information

NPI: 1174769384
Provider Name (Legal Business Name): ASCENTRIA COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SHEEP DAVIS ROAD SUITE A-1
CONCORD NH
03301
US

IV. Provider business mailing address

261 SHEEP DAVIS ROAD SUITE A-1
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-8111
  • Fax: 603-224-0798
Mailing address:
  • Phone: 603-224-8111
  • Fax: 603-224-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNH

VIII. Authorized Official

Name: MS. ANGELA BOVILL
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 774-243-3900